We Are Facing a Crisis, But There Is a Way to Solve It
By Bruce H. Robinson, MD, FACS, MSOM (Hon)
As most acupuncturists are well-aware, Oriental medicine is facing a crisis, caught between meager insurance reimbursements on the one hand and the efforts of some legislators and certain groups of physiatrists and other physicians to marginalize the TCM profession on the other.
New graduates of TCM colleges across America are having a difficult time getting established in a practice that can pay their bills and earn them a living.
At the same time, great numbers of American patients now have confidence in acupuncture and herbal therapy. Along with patient growth, TCM practitioners face the possibility of unparalleled growth if they can get their own house in order. This will require a two-pronged approach:
Increasing the professionalism of TCM practice by upgrading academic standards of TCM colleges and instituting high-quality doctorate programs around the country.
Making concerted efforts to better integrate TCM practices within the U.S. health care system.
This upgrade of the practice of Oriental medicine does not require any "Westernizing" of the medicine itself. I know many practitioners fear such an outcome, but the principles of Chinese medicine are deeply established and have stood the test of time. It's also true that many of the ancient writings can be reinterpreted in light of modern scientific understanding. Such a careful reinterpretation reveals that many breakthroughs in Western medical understanding, such as the circulation of the blood, were understood in their own terms by ancient Chinese medical observers. It might be that many TCM practitioners do not know how widely Chinese medicine in ancient times embraced concepts of physiology and pathology that have become a working part of the Western medical system. This is one way I see that the two medicines can draw closer together over the ensuing years. I am excited about this prospect.
What this upgrade also requires is for practitioners to learn more than many currently know about modern Western medicine. This means to learn how to serve as a resource for Western MDs; how to provide much-needed support for medical doctors' sickest patients; how to know when to refer red-flag cases to the appropriate medical facility; how to interpret lab values; and how to create appropriate medical reports.
In the final analysis, this means Oriental medical practitioners need to learn how to communicate with MDs in their own language. No one expects them to become experts in Western disease management, but when they have a working knowledge of Western medical terms and diseases, they can become an active part of the heath care team; a cooperative resource, rather than a competitor that medical doctors don't understand or trust. This type of integration clearly is in the best interest of the patient. A patient with diabetes mellitus, for example, can be benefited most with a combination approach that includes Western medical pharmaceuticals, an appropriate diet and lifestyle, and Oriental medical treatments.
Facing the Crisis
I believe every TCM practitioner and every student should ask themselves an important question: What will TCM practice be like in America 15 years from now? There are two vastly different possibilities:
Chinese medicine in America largely will go away. It's possible that if present trends continue, the practice of Chinese medicine in this country will shrivel on the vine. If so, this will be a process operating from the top down and from the bottom up. At the top, the physicians who have felt the most competition from TCM practitioners (such as physiatrists, orthopedists and other workers' compensation physicians) will work even harder to squeeze out third-party payments to acupuncturists. At the ground level, graduates from TCM colleges will have an increasingly hard time getting a practice established, and the success rate of graduates will continue to diminish (it's already way too low). In this highly possible outcome, Oriental medicine eventually will consist primarily of a few (mostly older) acupuncturists who practice entirely on their own, many of them Chinese or Korean, who have been able to hold on to their loyal clientele. Those who have a historic view know this has happened on several occasions in the past two centuries, when Chinese medical practice has been introduced into the U.S., has flourished for a time, and has then withered.
Chinese medicine will become a major medical force here in the U.S. If a majority or a significant minority of TCM practitioners can begin to integrate their practices into the Western health care system, Oriental medicine can become a powerful force for good in our society, benefiting thousands of needful patients, especially those with severe illness such as cancer and other advanced chronic diseases. This will require acupuncturists to learn much more about the Western system than they now know, to be able to converse with MDs about their patients, to become facile at cross-referrals, to read and create high quality Western medical reports, and to understand clearly when to refer patients out.
Every Western physician knows they need backup resources. All take pride in being able to say, "Mrs. Jones, I'm not the best person to help you with this situation, but I know someone who can really help you." Practically all MDs have a list of phone numbers for such referrals. TCM practitioners need to be on that list! Medical doctors also feel satisfaction and relief in being able to say, "Mr. Brown, you'll benefit from my treatment of your cancer, but it will have some severe side effects. I'm going to refer you to a Chinese medicine specialist I work with who can help you get through all this in the easiest way possible."
A Time to Shake Hands
I experienced a symbolic moment not too long ago while speaking as a Western physician on behalf of Chinese medicine at a TCM convention in San Francisco. I mentioned that it was time for Chinese medicine and Western medicine to begin to work together - a time to shake hands. The president of the California State Oriental Medical Association happened to be at the convention, and walked on to the speaker's platform with his hand out. Flash bulbs were popping as he and I engaged in a firm handshake. This successful integration of the two great medicines has indeed begun, but it needs to increase its momentum.
I salute those who are working to upgrade the level of education provided by TCM training programs. In the mid-1990s, after retiring from a 30-year surgical practice, I felt drawn toward my second love, Chinese medicine. I started teaching Western medicine in a large TCM college in California. I became continually more involved in the administrative aspects of Chinese medicine education, and eventually became the academic director.
I recall those days, not so long ago, when only 2,600 hours were required to obtain a master's degree in Chinese medicine and begin practice as a primary care provider! In some TCM colleges then, it was even fewer hours than that. As a Western physician, the prospects of some of these graduates, so "green behind the ears," assuming the full responsibilities of medical care providers was a bit frightening. I personally was gratified when legislation was passed in California making it necessary for programs to require 3,000 hours of education and training. I was even more pleased when several visionary TCM educators began to organize materials to create doctoral programs, adding another 1,000 hours in many cases, much of it consisting of biomedicine topics. I wholeheartedly support such efforts. This will hasten the day when all true health care professionals will be at a similar level of education and competence. I'm also happy to see the emergence of specialty-training programs, such as orthopedics and internal medicine.
It is my intention to write a series of articles for Acupuncture Today in which I will provide information to TCM practitioners about the successful integration of Chinese and Western medicine in our health care system, while never intending to alter or diminish Chinese medicine's powerful uniqueness. The many branches of Chinese medicine should remain true to their historic roots. I do believe, however, that if TCM practitioners learn how to relate, integrate and communicate with the Western health care system, they can then unleash their true power to benefit others and relieve human suffering.
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